A Census Day Audit of Mental Health Independent Sector Placements in the West Midlands
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A census day audit of ment al health independent sector placements in the West Midlands Authors: Dr Tony Ryan Dr Barbara Hatfield Indhu Sharma & Dr Vicky Simpson February 2005 ‘A census day audit of mental health independent sector placements in the West Midlands’ 2 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Contents Page 4 Acknowledgements Page 5 Executive summary Page 7 Terminology Page 8 Background and references Page 11 Aims Page 12 Methods Page 14 Recommendations Page 18 Appendix 1 Response rate and numbers of cases across the West Midlands Page 19 Appendix 2 Adjusted registered PCT, provider Trust and SHA populations (all ages) Page 21 Appendix 3 West Midlands overview Page 29 Appendix 4 Birmingham & the Black Country SHA area Adult placements Older people CAMHS Forensic Page 64 Appendix 5 West Midlands South SHA area Adult placements Older people CAMHS Forensic Page 97 Appendix 6 Shropshire & Staffordshire SHA area Adult placements Older people CAMHS Forensic Page 131 Appendix 7 Data providers Page 132 Appendix 8 Provider Trusts in the West Midlands Page 133 Appendix 9 Data collection proforma ‘A census day audit of mental health independent sector placements in the West Midlands’ 3 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Acknowledgements We are indebted to a number of people who have supported this project in many ways. In particular they are: • Staff of the 45 organisations across the West Midlands who participated in developing the data collection proforma and diligently provided the data for the project. • NIMHE West Midlands Regional Development Centre who sponsored the project, in particular Alastair McIntyre, Dr Ian McPherson, Gemma Parfitt and Gemma Boraston. • Jennifer Wells at the Commission for Social Care Inspection • Anthony Deery at the Healthcare Commission ‘A census day audit of mental health independent sector placements in the West Midlands’ 4 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Executive summary • All 45 commissioners of secondary mental health services in the West Midlands were invited to participate in a census day (28th June 2004). This covered 30 Primary Care Trusts, 14 Local Authority Social Services Departments and the Specialised Commissioning Services Agency. • The aims of the project included: – mapping all out of sector placements, – identifying characteristics people placed, – establishing expenditure, – providing baseline information for service and system development, and – stimulating collective action amongst commissioners in the West Midlands. • Information was obtained for people placed in independent sector facilities registered with the Healthcare Commission or Commission for Social Care Inspection. All mental health groups were included except those with dementia funded solely by LASSDs in care homes. • Response rates were high from the 45 organisations: CAMHS (100%, 45), adults (100%, 45) and older people (97.8%, 44). • Important information was not known to commissioners in over 25% of cases in the following areas: – diagnosis, – legal status, and – suitability of placement • The specialised commissioning agency provided the data for forensic services and had considerably less “don’t know” responses than other commissioners. The role of dedicated case managers for placements in the independent sector is likely to be a key factor in this. • Less than 20% of placements were in the voluntary sector. • Local Authority Social Services Departments funded the majority of placements while health commissioners provided the greater amount of funding. • A total of 440 organisations were commissioned, 25 of which accounted for 41% of placements. A further 240 organisations provided only one placement each and accounted for 11.2% of all placements. • The data points to a number of areas where collaborative commissioning could make a significant impact e.g. in managing high volume multiple contract providers, commissioning specialist services across SHA or the West Midlands for illnesses such as Korsakoff’s Syndrome and Huntington’s Disease. • Over 50% of cases are in the Birmingham and the Black Country SHA area. ‘A census day audit of mental health independent sector placements in the West Midlands’ 5 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) • Many people are placed at geographical distance from area and services of origin. • Based on the census day figures the expenditure of the year would be over £94M Birmingham and the Black Country = £43.6M; West Midlands South = £27.7; Shropshire and Staffordshire SHA = £22.7M) • Descriptive statistics are used throughout this report and have not been weighted for direct comparison purposes. Future examination of the data will seek to undertake this form of analysis. ‘A census day audit of mental health independent sector placements in the West Midlands’ 6 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Terminology Independent sector The “independent sector” is a term often given to non-statutory sector service providers and a range of terminology are used to describe this area, sometimes confusingly. For the purposes of this work the independent sector has been used as a term to cover both voluntary (charitable/not for profit) and private (profit making) sectors. The West Midlands The geographical area covered by the following Strategic Health Authorities: Birmingham and the Black Country SHA, West Midlands South SHA and Shropshire and Staffordshire SHA. Out of sector placement A placement into the independent sector made by commissioners of secondary mental health services. ‘A census day audit of mental health independent sector placements in the West Midlands’ 7 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) Background Mental health placements of people outside the area where they live and outside the geography of the local service commissioners (commonly referred to as “out of area treatments” – OATS) occur into statutory and independent sector services (voluntary and private). This is significant across the country and is of concern to many who are responsible for funding services. While these are often very useful many issues are raised in respect of quality, cost, appropriateness, monitoring, return of area of origin, distance from relatives, etc. (Poole et al, 2002; Ryan et al, 2004). A clear picture of the size of the expenditure and in particular the characteristics of some of the groups that are placed out of sector has not been available to date. The past 20 years has seen the independent sector grow and develop considerably. It is now a major provider of services that were once almost exclusively delivered by statutory sector agencies (NHS and social services/Local Authorities). It has been estimated that there were 28,766 beds in 1,507 private hospitals and nursing homes in England in 2001 (this does not include voluntary sector), of which 196 were registered to take people under the Mental Health Act 1983 (DoH, 2002). This represents a significant number of service users. By contrast there were 32,783 NHS in-patient mental health beds available, of which 3,849 were classified as non-elderly “long stay” in 2001/02 (DoH, 2003a). Therefore, the private and voluntary sectors constitute a significant proportion of total psychiatric bed capability. Additionally, 34% of secure psychiatric provision in England is now privately owned (DoH 2000/1). In October 2000 in England 491 patients were detained under the Mental Health Act in 10 private secure facilities (DoH 2000/1) and a total of 1,700 patients were detained in private mental nursing homes (DoH 2001). The growth in registered facilities as independent hospitals, care homes with nursing or care homes shows no sign of abating. By 31st March 2005 the Healthcare Commission estimate that there will be 229 Private and Voluntary Healthcare registered establishments with approximately just over 6,000 beds (Healthcare Commission, 2004). In November 2004 there were 201 care homes and care homes with nursing registered in the West Midlands with the Commission for Social Care Inspection to support people with a mental illness and they provide 3,974 beds in total (Commission for Social Care Inspection, 2005). Services delivered by the independent sector cover almost all the areas that NHS and Local Authority providers work in; from eating disorder services through to secure services. With a dispersed range of services many service users have been moved away from their families and communities and lost or damaged important relationships as a result. Many have also been excluded from their home communities and from local services. Many stakeholders acknowledge that there is considerable variability in the independent sector. Some providers appear to have exploited the market and have not delivered services of an acceptable quality. Independent sector providers aiming to deliver high ‘A census day audit of mental health independent sector placements in the West Midlands’ 8 Ryan T, Hatfield B, Sharma I & Simpson V – HASCAS & Manchester University (2005) quality services have an interest in ensuring that poor quality services do not tarnish the reputation of the rest of the sector. There are key differences between how private and voluntary sectors operate in relation to service development. Private sector organisations have the ability to responded to market opportunities